How to Fight a Nursing Home Discharge in Tennessee

The nursing home says your parent has to leave. Maybe they claim they "can't meet your parent's needs." Maybe Medicare coverage ended and they want a private-pay or Medicaid patient out to free up a bed. Whatever the stated reason, Tennessee nursing home residents have strong legal protections — and the facility can't just wheel them to the door.

The Only Six Legal Reasons for Involuntary Discharge

Under federal regulations (42 CFR § 483.15), a nursing home can involuntarily discharge a resident only for these specific reasons:

1. The facility genuinely cannot meet the resident's medical needs
2. The resident's health has improved to the point where nursing home care is no longer necessary
3. The resident's presence endangers the safety of other residents
4. The resident's presence endangers the health of other residents
5. The resident has failed to pay after receiving reasonable notice and opportunity
6. The facility is closing

That's the complete list. A facility that discharges for any other reason — including the end of Medicare coverage, the transition from private pay to Medicaid, or "difficult" behavior that hasn't been properly managed — is violating federal law.

What the Facility Must Do First

Before any involuntary discharge, the facility must provide written notice to the resident and their legal representative at least 30 days in advance. The notice must use Tennessee's official Involuntary Transfer or Discharge form and include:

• The specific legal reason for the discharge (one of the six above)
• The effective date
• A safe, specific destination where the resident will be transferred
• Information about the right to appeal

The facility must also send a copy of the notice to the State Long-Term Care Ombudsman at [email protected]. No transfer can occur until five business days after both the state ombudsman and the Department of Health have been notified.

How to Appeal

Your parent has 30 days from receiving the notice to file an appeal. If an appeal is filed, the discharge is frozen — the resident stays in the facility while the appeal is processed.

File the appeal with TennCare's Commissioner's Designee:

• Phone: 1-833-582-1224
• Fax: 615-734-5317
• Email: [email protected]

A formal contested case hearing must be scheduled within 90 days of the appeal filing. The hearing is conducted by an administrative judge under the Uniform Administrative Procedures Act, and the facility bears the burden of proving the discharge is justified.

The Medicaid Pending Protection

If the facility is pushing for discharge because your parent can't afford the private-pay rate and TennCare hasn't approved their application yet, this is likely illegal. A nursing home cannot discharge a resident for non-payment while a TennCare CHOICES application is pending or during an appeal of a Medicaid denial.

Your parent is required to pay their estimated patient liability during the pending period (gross income minus the $70 Personal Needs Allowance and insurance premiums), but family members are not personally responsible for any balance. If TennCare approves the application, it retroactively covers the facility's costs.

What to Do Right Now

Contact the Long-Term Care Ombudsman immediately. The ombudsman is a free, independent advocate who can intervene on your parent's behalf, review the discharge notice for procedural deficiencies, and help you file the appeal. Find your district ombudsman through the Tennessee Department of Disability and Aging.

Do not voluntarily agree to the transfer before reviewing the notice. File an appeal within 30 days of receiving the notice to preserve the right to remain in the facility while the appeal is pending. Ask the ombudsman or an attorney before signing anything.

Document the facility's stated reasons. If they claim they can't meet your parent's needs, ask for specific documentation: what care needs are unmet, what steps did they take to address them, and what evidence shows the receiving facility can do better? Vague claims without clinical backup weaken the facility's case at a hearing.

Check for retaliation. If the discharge notice followed a complaint you filed, a request for additional services, or a Medicaid transition, document the timeline. Retaliatory discharges are prohibited and strengthen your appeal.

The Tennessee hospital discharge transition toolkit covers involuntary discharge rights in detail, including pre-written appeal language and a timeline tracker for the 30-day notice and hearing process.

See more Tennessee guides →